Osseointegration Process Research Articles

Fundamental study on the construction of anti-wear drug delivery system through the design of titanium surface morphology

The durability of dental implant carrier coatings is of paramount importance for the expeditious and predictable osseointegration process. The present work is based on a bionic micro/nano hierarchy structure, which consists of titanium surface microstructures and their internal TiO2 nanotubes (TNTs) with drug-carrying capacity. This effectively increases the wear resistance of the drug-carrying coating on the titanium surface. In comparison to untextured samples, the wear volume and wear depth of the optimal texture group are markedly diminished, resulting in a significant enhancement of wear resistance. This improvement was primarily attributed to the smaller contact area of the microstructure. Concurrently, the microstructure serves to safeguard the TNTs from damage during friction. The hydrophilic biomimetic anti-wear micro/nano hierarchies demonstrated the capacity to promote MC3T3-E1 cell adhesion and proliferation, while also exhibiting no cytotoxic effects. Moreover, the micro/nano hierarchical structure can be directly applied to the surface of commercialized implants. In simulated clinical conditions, the implant was inserted into a fresh Bama porcine mandible, and the structure of the drug-loading coatings remained intact. This structure enhances the abrasion resistance of the drug coating while minimizing alterations to the original treatment process of the implant, which is of great significance in the clinical application of implant-loaded drug delivery.

Does an Osteoporosis-like Condition Jeopardize the Osseointegration Process around Dental Implants Placed in Animal Models? A Systematic Review.

Knowing that osteoporosis is a metabolic disease that could decrease dental implant success and survival, the purpose of this review was to gather information on the characteristics of implant osseointegration in animal models of induced osteoporosis. By pointing out the role of some factors that could improve the success rate in these situations, this study aimed to enhance the knowledge about this process that can be further translated to clinical designs. A systematic search in PubMed/Medline, Lilacs, Cochrane Library, Scopus and Web of Science was conducted to identify information between 2002 and 2023 regarding osseointegration of dental implants in animal models of induced osteoporosis. The following search strategy was utilized and adjusted to each database: (((dental implant) AND (Osseointegration)) AND (osteoporosis)) AND/OR (osteoporosis treatment). The inclusion criteria were animal studies in English, involving the placement of an osseointegrated implant in osteoporotic bone, and evaluating bone to implant contact (BIC) %. Exclusion criteria were studies in humans, in vitro studies, procedures involving any kind of bone graft and studies evaluating medication related osteonecrosis of the jaw. A standardized data extraction form was used to record data for each study, covering article title, date, authors, number of animals, purpose of study, type of analysis used by authors, follow-up, type of implant, test and control groups, intervention and conclusions. The risk of bias of the included studies was assessed using the Systematic Review Centre for Laboratory animal Experimentation (SYRCLE) Risk of Bias tool.20 Results: A total of 204 articles were found for evaluation and selection. All of the 43 selected studies evaluated the bone-implant contact (BIC) %. Other parameters such as bone to implant mechanical interface, bone area (BA) and bone volume (BV) ratio were also evaluated in some of the studies. There was a tendency for compromised results of implant osseointegration in the presence of osteoporosis. Modification of the implant surface, systemic and local use of anti-resorptive drugs and other substances, showed benefits for the implant success in osteoporotic sites. Still, no consensus among studies on the superiority of systemic medications in improving the process of peri-implant bone repair, was observed. Although it is possible to improve the osseointegration of implants in osteoporotic bone, either by using systemic or local factors, the metabolic bone syndrome caused by osteoporosis can jeopardize the osseointegration of dental implants.

The effectiveness of using mesodiencephalic modulation in combination with ozone therapy in patients with peri-implantitis according to long-term results of the study

BACKGROUND: Evaluation of the clinical effectiveness of the use of various treatment regimens for peri-implantitis should take into account not only the immediate results achieved during treatment, but also the manifestations of the disease in the long-term period. AIM: Assessment of the effectiveness of the integrated use of mesodiencephalic modulation (MDM therapy) and ozone therapy in patients with dental peri-implantitis based on long-term results of the study. MATERIALS AND METHODS: The study was carried out with the participation of 116 patients with peri-implantitis of classes I and II according to S.A. Jovanovic. Using the fixed randomization method, all patients were divided into 4 groups based on the results of generating random numbers obtained using a computer program. Patients of the first group (control group, n=28) received standard dental therapy, including professional oral hygiene and local use of antiseptics. Patients of the second group (comparison group 1; n=29) received a course of ozone therapy in addition to standard dental therapy, for which the periimplant area was irrigated with ozonated saline solution with an ozone concentration of 2.5–5.5 μg/ml for 15 minutes. Patients of the third group (comparison group 2; n=30) received a course of MDM therapy in addition to standard dental therapy. In the fourth group (main group; n=29), patients, along with standard dental therapy, received a course of complex physiotherapy in the form of a combination of ozone and MDM therapy. Long-term results of complex therapy for peri-implantitis were assessed 6 and 12 months after the end of treatment. RESULTS: A comparative assessment of dental indices in the long-term period showed that the addition of SST with a course of physiotherapeutic effects, in general, is accompanied by the preservation of the effect achieved after the end of treatment. At the same time, the best results were noted in the main group with the combined use of ozone and MDM therapy. Changes in the osseointegration index also indicated the preservation of the values achieved after the end of therapy, and in the main group a significant increase in this parameter was observed, which indicated additional activation of osseointegration processes under the influence of the physiotherapeutic complex. CONCLUSION: The results of the performed follow-up study convincingly prove the advantages of the additional use of therapeutic physical factors (MDM therapy, ozone therapy and their combination).

Evaluation of the immune response of peripheral blood mononuclear cells cultured on Ti6Al4V-ELI polished or etched surfaces.

While titanium and its alloys exhibit excellent biocompatibility and corrosion resistance, their polished surfaces can hinder fast and effective osseointegration and other biological processes, such as angiogenesis, due to their inert and hydrophobic properties. Despite being commonly used for orthopedic implants, research focuses on developing surface treatments to improve osseointegration, promoting cell adhesion and proliferation, as well as increasing protein adsorption capacity. This study explores a chemical treatment intended for titanium-based implants that enhances tissue integration without compromising the mechanical properties of the Ti6Al4V substrate. However, recognizing that inflammation contributes to nearly half of early implant failures, we assessed the impact of this treatment on T-cell viability, cytokine production, and phenotype. Ti6Al4V with extra low interstitial (ELI) content discs were treated with hydrofluoric acid followed by a controlled oxidation step in hydrogen peroxide that creates a complex surface topography with micro- and nano-texture and modifies the chemistry of the surface oxide layer. The acid etched surface contains an abundance of hydroxyl groups, crucial for promoting bone growth and apatite precipitation, while also enabling further functionalization with biomolecules. While cell viability remained high in both groups, untreated discs triggered an increase in Th2 cells and a decrease of the Th17 subset. Furthermore, peripheral blood mononuclear cells exposed to untreated discs displayed a rise in various pro-inflammatory and anti-inflammatory cytokines compared to the control and treated groups. Conversely, the treated discs showed a similar profile to the control, both in terms of immune cell subset frequencies and cytokine secretion. The dysregulation of the cytokine profile upon contact with untreated Ti6Al4V-ELI discs, namely upregulation of IL-2 could be responsible for the decrease in Th17 frequency, and thus might contribute to implant-associated bacterial infection. Interestingly, the chemical treatment restores the immune response to levels comparable to the control condition, suggesting the treatment's potential to mitigate inflammation by enhancing biocompatibility.

Influence of Tibial Component Design Features and Interference Fit on Implant-Bone Micromotion in Total Ankle Replacement: A Finite Element Study.

Implant survivorship in uncemented total ankle replacement (TAR) is dependent on achieving initial stability. This is because early micromotion between the implant and bone can disrupt the process of osseointegration, leading to poor long-term outcomes. Tibial implant fixation features are designed to resist micromotion, aided by bony sidewall retention and interference fit. The goal of this study was to investigate design-specific factors influencing implant-bone micromotion in TAR tibial components with interference fit. Three implant designs with fixation features representative of current TAR tibial components (ARC, SPIKES, KEEL) were virtually inserted into models of the distal tibias of 2 patients with end-stage ankle arthritis. Tibia models were generated from deidentified patient computed tomography scans, with material properties for modeling bone behavior and compaction during press-fit. Finite element analysis (FEA) was used to simulate 2 fixation configurations: (1) no sidewalls or interference fit, and (2) sidewalls with interference fit. Load profiles representing the stance phase of gait were applied to the models, and implant-bone micromotions were computed from FEA output. Sidewalls and interference fit substantially influenced implant-bone micromotions across all designs studied. When sidewalls and interference fit were modeled, average micromotions were less than 11 µm, consistent across the stance phase of gait. Without sidewalls or interference fit, micromotions were largest near either heel strike or toe-off. In the absence of sidewalls and interference fit, the amount of micromotion generally aligned inversely with the size of implant fixation features; the ARC design had the largest micromotion (~540 µm average), whereas the KEEL design had the smallest micromotion (~15 µm). This study presents new insights into the effect of TAR fixation features on implant-bone micromotion. With sidewalls and interference fit, micromotion is predicted to be minimal for implants, whereas with no sidewalls and no interference fit, micromotion depended primarily on the implant design. This study presents new insights into the effect of TAR primary fixation features on implant-bone micromotion. Although design features heavily influenced implant stability in the model, their influence was greatly diminished when interference fit was introduced. The results of this study show the relative importance of design features and interference fit in the predicted initial stability of uncemented TAR, potentially a key factor in implant survivorship.

Synergistic effects of calcium and zinc on bio-functionalized 3D Ti cancellous bone scaffold with enhanced osseointegration capacity in rabbit model

The present research aims to develop a Ca-Zn ion-incorporated surface functionalized 3D Ti cancellous bone scaffold for bone defect repair. The scaffold is designed to mimic human cancellous bone architecture through selective laser melting-based additive manufacturing. The chemical-based surface modification approach employed here created a Ca and Zn ions incorporated nano-porous surface layer with enhanced surface roughness and hydrophilicity. The modified biomimetic scaffold improved corrosion resistance behaviour with ICORR and ECORR values of 0.174 and 0.0097 respectively. It is learned that incorporating Zn as ZnO over the scaffold has antibacterial activity against Staphylococcus aureus and Escherichia coli. The cellular response of MG-63 to the modified scaffold was evaluated through in-vitro studies which focus on the cytocompatible properties. The intra-osseous biomimetic Ti-Na-Ca:Zn 3D scaffold revealed significant improvement in the osseointegration capabilities in terms of bone mineral density (BMD) and bone volume/total volume (BV/TV) in the rabbit model. The osseointegration potential at the Ti-Na-Ca:Zn interface was evidenced by histological analysis and micro-CT imaging. In addition to this, the remarkable upregulation of osteogenic genes such as OCN, COL1A1, OPN, ALP, RUNX2, and OSX evidences the dynamics of the osseointegration process at each surgical period. This Ca and Zn surface functionalised porous architecture of the 3D Ti cancellous bone scaffold similar to bone with enhanced biological response and bone integration can potentially allow implant customisation by utilizing additive manufacturing technology with improved clinical outcomes.

Factors affecting osseointegration of dental implants (literature review)

The article’s material based on sources from peer-reviewed scientific journals on the issues of osseointegration of dental implants. The main factors influencing the process of osseointegration: composition and surface of the implant, bone density, general health of the patient, primary stability of the implant, hygiene, and the impact of physiotherapeutic methods. The last factor requires special attention due to how insufficiently it’s been studied.

Influence of surface texturing and coatings on mechanical properties and integration with bone tissue: an in silico study.

This investigation delves into the mechanical behaviour of titanium dental implants, a preferred choice for tooth replacement due to their superior reliability over alternative materials. The phenomenon of implant loosening, frequently induced by masticatory activities, underscores the significance of surface modification or texturing to bolster the interaction between the implant and bone tissue. This research comprehensively examines the effects of four distinct surface texturing techniques and five varied bone quality conditions on the biomechanical performance of these implants. The scope of this study is delineated by its focus on implants of diameters 4mm and 6mm, with lengths measuring 9mm and 12mm respectively. Furthermore, the analysis incorporates the evaluation of four different coatings-hydroxyapatite, HA3TO, HA3Sr, and HA1.5TO1.5Sr-to investigate their efficacy in enhancing the osseointegration process on textured surfaces of dental implants. The experimental design entails the assessment of stress distribution within the implant and its coatings, alongside the strain exerted on the surrounding cancellous bone, under the conditions of an average vertical biting force. A comparative analysis between solid implants and those subjected to surface texturing techniques has been conducted. This comparison elucidates the advantageous microstrain profiles presented by certain textured surfaces, which are deemed more conducive to optimal osseointegration. Notably, across all examined textures, the application of hydroxyapatite (HA) and a modified HA composition (HA1.5TO1.5Sr) demonstrates significant improvements in mechanical stability, particularly in scenarios involving weak and very weak bone conditions. This study's findings contribute to the ongoing advancement in dental implant technology, emphasizing the critical role of surface texturing and coating strategies in promoting implant longevity and integration within the biomechanical environment of the human oral cavity.

Surface Analysis of Orthodontic Mini-Implants after Their Clinical Use.

Temporary anchorage devices (TADs) are orthodontic mini-implants with remarkable characteristics that, once inserted, present mechanical retention (primary stability) without the process of bone osseointegration. However, interaction with the biological environment may cause changes in the morphology of the external surface of dental TADs. In this study, we used 17 TADs made of aluminum-vanadium titanium alloy, produced by two companies, which were analyzed through optical microscopy after being removed from the patients during orthodontic treatment. We evaluated the changes that appeared on the TADs' surfaces after their use in the biological environment, depending on the morphological area in which they were inserted. In our study, we found changes in the morphology of the implant surface, and especially deposits of biological material in all study groups. On all samples examined after clinical use, regardless of the period of use, corrosion surfaces in different locations were observed. Our obtained results support the idea that the biological environment is aggressive for mini-implant structures, always producing changes to their surface during their clinical use.

Novel Technique for Alveolar Ridge Expansion: A Comparative Clinical Study

Background: Piezosurgery improved the split approach by making it safer, easier, and less prone to complications when treating extremely atrophic crests. Densah drills, with their unique design, expand the ridge by densifying bone in a reverse, non-cutting mode. Objective: To assess the effectiveness of sagittal piezosurgery, which involves cutting bone to the full implant depth and then expanding it using osseodensification drills. We use this technique to expand narrow alveolar bones and simultaneously place dental implants in the maxillary and mandibular arches. Methods: Fourteen patients received 31 dental implants. The maxillary arch received 19, and the mandible received 12 dental implants. This study will include patients who have narrow alveolar bone ridges (2.5–4 mm). After marking the implant sites with a pilot drill, we used a piezoelectric surgery tip to cut the alveolar crest to the depth of the planned dental implant. We then sequentially used Versah Drills, accompanied by extensive irrigation using cooled, sterile normal saline, and finally inserted the implant into the subcrestal level. Results: This study revealed a significant difference in alveolar ridge width immediately after the procedure, and the significant change in the mandible was slightly higher than that in the maxillary arch. However, all implants in both jaws achieved successful osseointegration. Conclusions: The alveolar ridge width changed a lot more in the mandible than in the maxillary arch after the procedure. These two strategies work well together to properly and simply expand severely atrophied alveolar ridges without affecting bone healing or the osseointegration process.

Evaluation of fracture resistance and marginal fit of implant-supported interim crowns fabricated by conventional, additive and subtractive methods

BackgroundInterim crowns are utilized for restoring implants during and after the process of osseointegration. However, studies on adaptation and fracture strength of implant-supported interim crowns are rare.Aim of the studyThe aim of this in vitro study is evaluating marginal fit and fracture resistance of conventional, subtractive, and additive methods of fabricating implant-supported interim crowns.Materials and methodsAn implant was placed in an epoxy resin model with a missing first molar. A scan body was attached, and scanned with an intraoral scanner (IOS), the STL file was used to fabricate eighteen master models with standardized implant digital analogue spaces. The digital analogues and their corresponding abutments were attached to the master models and scanned with the IOS, the STL files were used to fabricate eighteen crowns using three different techniques (n = 6): conventional (CR); from Autopolymerizing composite resin, subtractive (SM); milled from PMMA resin blanks, and additive (AM); from 3D printed resin material. The crowns were fitted and cemented on their corresponding abutments and subjected to cyclic loading and thermocycling. The marginal fit was evaluated using a stereomicroscope. The crowns were then loaded until fractured in a universal testing machine. The Shapiro–Wilk and the Kolmogorov-Smirnov tests revealed that data of Marginal gap was non-parametric. Kruskal-Wallis test followed by the Dunn test was used (α = 0.05). While data of Fracture resistance test was parametric. ANOVA (F-test) was used followed by the Tukey test (α = 0.05).ResultsFor marginal gap, a significant difference was shown between the study groups (P = .001) according to Kruskal–Wallis test. Groups SM and AM had significantly lower marginal gap values compared to group CR (P = .003). No significant difference was found between groups SM and AM (P = .994). For fracture resistance, One-way ANOVA revealed a significant difference in fracture resistance between study groups (P < .001). Group SM had significantly higher fracture strength followed by group AM and group CR (P = .001).ConclusionsGroup SM and AM showed better marginal adaptation than group CR. Group SM showed superior fracture resistance compared to other groups. All study groups showed acceptable marginal gap and fracture resistance.

Presenting dual-functional peptides on implant surface to direct in vitro osteogenesis and in vivo osteointegration

The complex biological process of osseointegration and the bio-inertness of bone implants are the major reasons for the high failure rate of long-term implants, and have also promoted the rapid development of multifunctional implant coatings in recent years. Herein, through the special design of peptides, we use layer-by-layer assembly technology to simultaneously display two peptides with different biological functions on the implant surface to address this issue. A variety of surface characterization techniques (ellipsometry, atomic force microscopy, photoelectron spectroscopy, dissipation-quartz crystal microbalance) were used to study in detail the preparation process of the dual peptide functional coating and the physical and chemical properties, such as the composition, mechanical modulus, stability, and roughness of the coating. Compared with single peptide functional coatings, dual-peptide functionalized coatings had much better performances on antioxidant, cellular adhesion in early stage, proliferation and osteogenic differentiation in long term, as well as in vivo osteogenesis and osseointegration capabilities. These findings will promote the development of multifunctional designs in bone implant coatings, as a coping strategy for the complexity of biological process during osteointegration.

Alendronate as Bioactive Coating on Titanium Surfaces: An Investigation of CaP-Alendronate Interactions.

The surface modification of dental implants plays an important role in establishing a successful interaction of the implant with the surrounding tissue, as the bioactivity and osseointegration properties are strongly dependent on the physicochemical properties of the implant surface. A surface coating with bioactive molecules that stimulate the formation of a mineral calcium phosphate (CaP) layer has a positive effect on the bone bonding process, as biomineralization is crucial for improving the osseointegration process and rapid bone ingrowth. In this work, the spontaneous deposition of calcium phosphate on the titanium surface covered with chemically stable and covalently bound alendronate molecules was investigated using an integrated experimental and theoretical approach. The initial nucleation of CaP was investigated using quantum chemical calculations at the density functional theory (DFT) level. Negative Gibbs free energies show a spontaneous nucleation of CaP on the biomolecule-covered titanium oxide surface. The deposition of calcium and phosphate ions on the alendronate-modified titanium oxide surface is governed by Ca2+-phosphonate (-PO3H) interactions and supported by hydrogen bonding between the phosphate group of CaP and the amino group of the alendronate molecule. The morphological and structural properties of CaP deposit were investigated using scanning electron microscopy, energy dispersive X-ray spectroscopy, X-ray diffraction and attenuated total reflectance Fourier transform infrared spectroscopy. This integrated experimental-theoretical study highlights the spontaneous formation of CaP on the alendronate-coated titanium surface, confirming the bioactivity ability of the alendronate coating. The results provide valuable guidance for the promising forthcoming advancements in the development of biomaterials and surface modification of dental implants.

Evaluation of innovative fluroapatite /silicon dioxide modified zirconia nanocomposites coated on Ti–13Nb–13Zr alloy for dental implant application

Dental implants are intended to function as a durable method for replacing missing teeth. A biocompatible dental alloy is used to achieve integration with the jawbone through Osseointegration. This creates a strong base for the implant, allowing it to withstand the mechanical forces generated during biting and chewing. Dental alloys are commonly subjected to various mouth conditions known for their intricate corrosion potential. Corrosion can weaken the structural integrity of the implant, causing issues such as implant loosening, micro-motion at the implant-bone contact, implant fracture, allergic reactions, toxicity, and possible disruption of the Osseo integration process. To improve the alloy's corrosion resistance and biocompatibility, its surface can be altered using nanocomposite materials. The materials provide a protective coating to the alloy, creating a physical barrier that effectively prevents corrosive substances from reaching the underlying bulk material. This study involves modifying the surface of the dental alloy Ti–13Nb–13Zr with Fluroapatite (FAP)/Silicon dioxide (SiO2) modified zirconia (ZrO2) nano composites. The altered surfaces are then studied in simulated body fluid and artificial saliva solutions using in vitro methods. The FAP/SiO2 modified ZrO2 nanocomposites is applied onto a Ti–13Nb–13Zr alloy utilizing Electrophoretic deposition and Dip coating techniques. The coated samples were analysis utilizing FTIR, XRD, and SEM with EDS. Corrosion analysis was carried out on coated and uncoated samples using Electrochemical methods in simulated body fluid and artificial saliva solution. The biocompatibility is assessed using MTT assay, contact angle, and immersion testing in both SBF and Artificial saliva. EIS and corrosion study results show that FAP/SiO2 modified ZrO2 nanocomposites coated Ti13Nb13Zr alloy has high polarization resistance, low corrosion rate, and good charge transfer resistance, indicating excellent corrosion resistance. The contact angle study showed that the surface-modified Ti13Nb13Zr alloy is superhydrophilic, increasing implant surface osseointegration. Cell viability measurements reveal good cell growth, while immersion investigations show calcification, leading to enhanced osseointegration between the implant and its surrounding tissues. hence, it is an excellent material for dental implants application.

Implant surface modifications and their impact on osseointegration and peri-implant diseases through epigenetic changes: A scoping review.

Dental implant surfaces and their unique properties can interact with the surrounding oral tissues through epigenetic cues. The present scoping review provides current perspectives on surface modifications of dental implants, their impact on the osseointegration process, and the interaction between implant surface properties and epigenetics, also in peri-implant diseases. Findings of this review demonstrate the impact of innovative surface treatments on the epigenetic mechanisms of cells, showing promising results in the early stages of osseointegration. Dental implant surfaces with properties of hydrophilicity, nanotexturization, multifunctional coatings, and incorporated drug-release systems have demonstrated favorable outcomes for early bone adhesion, increased antibacterial features, and improved osseointegration. The interaction between modified surface morphologies, different chemical surface energies, and/or release of molecules within the oral tissues has been shown to influence epigenetic mechanisms of the surrounding tissues caused by a physical-chemical interaction. Epigenetic changes around dental implants in the state of health and disease are different. In conclusion, emerging approaches in surface modifications for dental implants functionalized with epigenetics have great potential with a significant impact on modulating bone healing during osseointegration.

Bone-to-Implant Contact in Implants with Plasma-Treated Nanostructured Calcium-Incorporated Surface (XPEEDActive) Compared to Non-Plasma-Treated Implants (XPEED): A Human Histologic Study at 4 Weeks

Titanium implants undergo an aging process through surface hydrocarbon deposition, resulting in decreased wettability and bioactivity. Plasma treatment was shown to significantly reduce surface hydrocarbons, thus improving implant hydrophilicity and enhancing the osseointegration process. This study investigates the effect of plasma surface treatment on bone-to-implant contact (BIC) of implants presenting a nanostructured calcium-incorporated surface (XPEED®). Following a Randomized Controlled Trial (RCT) design, patients undergoing implant surgery in the posterior maxilla received additional plasma-treated (n = 7) or -untreated (n = 5) 3.5 × 8 mm implants that were retrieved after a 4-week healing period for histological examination. Histomorphometric analysis showed that plasma-treated implants exhibited a 38.7% BIC rate compared to 22.4% of untreated implants (p = 0.002), indicating enhanced osseointegration potential. Histological images also revealed increased bone formation and active osteoblastic activity around plasma-treated implants when compared to untreated specimens. The findings suggest that plasma treatment improves surface hydrophilicity and biological response, facilitating early bone formation around titanium implants. This study underscores the importance of surface modifications in optimizing implant integration and supports the use of plasma treatment to enhance osseointegration, thereby improving clinical outcomes in implant dentistry and offering benefits for immediate and early loading protocols, particularly in soft bone conditions.

Investigation of structure, morphology, and corrosion behavior of carboxylic acids/hydroxyapatite/chitosan coatings on Ti discs for implants

Titanium (Ti) and its alloys are widely used in bone defect repair owing to their advantages, including high strength, corrosion resistance, and biocompatibility. The formation of a stable oxide layer on Ti implants enhances the osseointegration process. Nevertheless, additional progress is required to improve the incorporation of these implants at the microscopic and nanoscopic levels to achieve a biocompatible interface. The main objective of this study was to enhance the morphology of hydroxyapatite and the corrosion resistance of Ti implants by applying hydroxyapatite/chitosan (HA/Cs) nanocomposite coatings embedded with carboxylic acids. The coatings were fabricated by electrodeposition, wherein various acid concentrations (acrylic and acetic acids) were employed as Cs electrolyte solvents to enhance the adhesion and bond strength with the titanium metal substrate. The microstructures of the HA/Cs coatings were analyzed using X-ray diffraction. The results demonstrated that the structure of HA was affected by the type of acid used and its concentration as the crystallinity increased with a high concentration of acrylic acid. Additionally, the morphology of HA/Cs was analyzed using a transmission electron microscope. The results showed that the morphology of HA/Cs changed from a hexagonal rod-like shape with acrylic acid samples into a needle-like shape in acetic acid samples. The corrosion behavior was investigated using electrochemical impedance spectroscopy (EIS) in a simulated body fluid (SBF) at 37±2ºC. The EIS results showed a high corrosion resistance with phase angles close to −80° and high impedance values of 80.5 kΩ cm2 with a high concentration of acrylic acid. These results indicated the formation of a highly adhesive and stable film on the implants in the test solution. In conclusion, based on this study and our previous work, the corrosion resistance, good biocompatibility, and biomineralization properties of the prepared HA/Cs-coated Ti recommend it as an alternative implant for clinical applications.

Titanium Surface Modification Techniques to Enhance Osteoblasts and Bone Formation for Dental Implants: A Narrative Review on Current Advances

Surface modifications for titanium, a material of choice for dental implants, can greatly alter the surface micro/nanotopography and composition of implants, leading to notable enhancements in their hydrophilicity, mechanical properties, osseointegration performance, and antibacterial performance, as well as their impacts on osteoblast activity and bone formation processes. This article aims to update titanium surface modification techniques for dental implants from the past to the present, along with their effects on osteoblasts and bone formation, by thoroughly summarizing findings from published studies. Peer-reviewed articles published in English consisting of in vitro, in vivo, and clinical studies on titanium dental implant surface treatments were searched in Google Scholar, PubMed/MEDLINE, ScienceDirect, and the Scopus databases from January 1983 to December 2023 and included in this review. The previous studies show that implant surface roughness, condition, and hydrophilicity are crucial for osteoblast adhesion and growth. While various techniques enhance osseointegration comparably, one of the most common approaches to accomplishing these properties is sandblasting large-grit acid etching surface treatment and coating with hydroxyapatite or chitosan. In conclusion, this review points out the efficacy of different subtraction and addition techniques in enhancing the surface properties of titanium dental implants, promoting favorable outcomes in terms of osteoblast activity and bone formation in various degrees. However, most existing studies predominantly compare treated and non-treated titanium, revealing a need for more comprehensive studies comparing the effects of various modification techniques. Moreover, further investigation of factors playing a role in the dynamic osseointegration process in addition to osteoblasts and their functions, as well as improved surface modification techniques for the treatment of compromised patients, is greatly required.

Peningkatan Ikatan Adhesi terhadap Pengurangan Retak Lapisan PVA pada Ti-6Al-4V ELI untuk Aplikasi Biomedis

The lack of adhesion bonding of the hydroxyapatite (HA) coating layer on the surface of implant material can cause the coating layer to peel off during implantation and will increase the risk of metallic ion release to human body and may also to increase inflammatory effect and slow down the osseointegration process. In order to increase the adhesion of HA coated Ti-6Al-4V ELI by adding Zirconium Oxide (ZrO2) into the coating layer.The coating process of the HA suspension with addition ZrO2 into Ti-6Al-4V ELI sample surfaces was conducted by using dip-coating method. The samples were then heated at 800, 900, and 950 °C. The improvement of adhesion coating was correlated by calculating the removed area. The low value of removed coating area indicated the adhesion coating is good. The test specimen with the addition of ZrO2, has a removed area fewer than the test specimen without the addition of PVA- ZrO2 has. This shows that the test specimen with the addition of ZrO2 has good coating adhesion.The addition of PVA- ZrO2 to the HA suspension increases adhesion bonding of the coating layer, as indicated by the low removed area as compared to that of without PVA- ZrO2 coating.

Pre-implantation teriparatide administration improves initial implant stability and accelerates the osseointegration process in osteoporotic rats

PurposeOsteoporotic individuals who have dental implants usually require a prolonged healing time for osseointegration due to the shortage of bone mass and the lack of initial stability. Although studies have shown that intermittent teriparatide administration can promote osseointegration, there is little data to support the idea that pre-implantation administration is necessary and beneficial.MethodsSixty-four titanium implants were placed in the bilateral proximal tibial metaphysis in 32 female SD rats. Bilateral ovariectomy (OVX) was used to induce osteoporosis. Four major groups (n = 8) were created: PRE (OVX + pre-implantation teriparatide administration), POST (OVX + post-implantation administration), OP (OVX + normal saline (NS)) and SHAM (sham rats + NS). Half of rats (n = 4) in each group were euthanized respectively at 4 weeks or 8 weeks after implantation surgery, and four major groups were divided into eight subgroups (PRE4 to SHAM8). Tibiae were collected for micro-CT morphometry, biomechanical test and undecalcified sections analysis.ResultsCompared to OP group, rats in PRE and SHAM groups had a higher value of insertion torque (p < 0.05). The micro-CT analysis, biomechanical test, and histological data showed that peri-implant trabecular growth, implants fixation and bone-implant contact (BIC) were increased after 4 or 8 weeks of teriparatide treatment (p < 0.05). There was no statistically difference in those parameters between PRE4 and POST8 subgroups (p > 0.05).ConclusionsIn osteoporotic rats, post-implantation administration of teriparatide enhanced peri-implant bone formation and this effect was stronger as the medicine was taken longer. Pre-implantation teriparatide treatment improved primary implant stability and accelerated the osseointegration process.